Steven B. Cannady

Free flap reconstruction for osteoradionecrosis of the jaws—Outcomes and predictive factors for success

The purpose of this study was to determine factors to predict the success of free flap surgery in the treatment of osteoradionecrosis (ORN).

Total parotidectomy defect reconstruction using the buried free flap

OBJECTIVE 1) Present an alternative method of total parotidectomy with or without neck dissection defect reconstruction that results in improved cosmesis. 2) Describe applications of free tissue transfer in parotidectomy defect reconstruction. STUDY DESIGN Case series with chart review. SETTING Two tertiary-care medical centers. SUBJECTS AND METHODS A two-institution retrospective review from 2002 to 2009 was conducted for buried free flaps utilized in reconstruction of defects from total parotidectomy with or without neck dissection. Patients with temporal bone or skin resections were excluded. Demographic information, tumor characteristics, surgical interventions, flap details, and adjunctive facial reconstructive techniques were recorded. Postoperative cosmetic results were evaluated by patient and physician satisfaction. RESULTS Eighteen patients with a mean age of 57.4 years underwent flap reconstruction. Total parotidectomy was performed in all cases, 11 cases required facial nerve sacrifice, and 14 cases included neck dissection. The anterolateral thigh flap was the most often utilized free flap. Mean flap area was 65.5 cm2. Adjunctive static facial reanimation was employed in eight patients. All flaps survived. Ten patients underwent adjuvant radiation. Free flap reconstruction resulted in cosmetic patient and surgeon satisfaction, despite adjuvant radiation therapy. CONCLUSION Free flap reconstruction of total parotidectomy (with or without neck dissection) defects is safe and effective. It does not preclude adjunctive facial reanimation and provides sufficient tissue bulk to match the contralateral facial contour despite radical resections and adjuvant radiation therapy in most cases.

Extent of neck dissection required after concurrent chemoradiation for stage IV head and neck squamous cell carcinoma

The management of initially bulky nodal disease after primary nonsurgical treatment for stage IV head and neck squamous cell carcinoma (HNSCC) continues to be a subject of debate.

The total nasal defect and reconstruction.

The structures of the nose are arguably the most complex within the face to reconstitute when absent. Total nasal reconstruction has evolved to encompass advanced surgical techniques in an effort to achieve increasingly satisfactory cosmetic results while restoring nasal function that mimics the function of a patients natural nose. In this article, the history of total nasal defects and their reconstruction, relevant nasal anatomy, etiologies of the defect, and the surgical approaches to reconstructing each of the three-layered structure of the nose (ie, nasal skin, cartilage/bone, and lining mucosa) are explored.

Interposition vein grafts in microvascular head and neck reconstruction

To understand when interposition vein grafting may be needed in head and neck reconstruction and become familiar with the factors associated with use of interposition grafts and their effect on free flap survival.

Comparison of complications in free flap reconstruction for osteoradionecrosis in patients with or without hyperbaric oxygen therapy

Hyperbaric oxygen (HBO) therapy induces native tissue oxygenation. The hypothesis was patients with mandibular osteoradionecrosis (ORN) and a history of HBO therapy would have less free flap reconstruction complications than patients without HBO therapy.

Free tissue transfer for head and neck reconstruction in solid organ transplant patients

Patients with head and neck malignancies who have had solid organ transplant and require free tissue transfer are a unique population. This study was performed to evaluate the effect of immunosuppression on the rate of perioperative complications and the success of free tissue transfer in the head and neck.

The use of nuclear bone scanning after fibula free tissue transfer

To understand the role of nuclear bone scanning in the evaluation of threatened osteocutaneous free tissue transfers, identify patients who may benefit from nuclear bone scanning after head and neck reconstructive surgery, and be able to use nuclear bone scanning to help guide management of the threatened free flap.

Progressive transformation of germinal centers (PTGC) in the head and neck

INTRODUCTION Progressive transformation of germinal centers (PTGC) was first described by Lennert and Muller-Hermelink in 1975 as enlargement of secondary follicles with blurring of the germinal center-mantle zone junction [1-3]. PTGC is a clinically asymptomatic condition characterized by persistent lymphadenopathy. PTGC is more common in males compared to females, with an approximate 3:1 ratio [4]. The etiology of PTGC is unknown, but is proposed to be a result of abnormal follicle hyperplasia following antigenic stimulation [1]. PTGC has been proposed to be part of a sequential spectrum of hyperplastic follicles, follicular lysis, and PTGC, with progressive ingression of mantle B cells [5]. The germinal center architecture consisting of centroblasts, centrocytes, plasma cells, and dendritic retinacular cells are largely replaced with small lymphocytes [1-3].

Endoscopic vein graft harvest in head and neck reconstruction

In modern head and neck reconstruction, free tissue transfer techniques have continued to show excellent utility. In instances in which the free-flap vascular pedicle length is inadequate to traverse the distance necessary for a tensionfree anastomosis, interposition vein grafts are used. In our experience, interposition grafts are necessary in approximately two percent of microvascular reconstructions. Concerns about increased free-flap failure related to the use of interposition grafts have been assuaged by retrospective series showing patency rates comparable to primary anastomosis. Despite some early concerns about increased rates of graft patency failure and the significant learning curve associated with endoscopic vein harvest (EVH), the technique has become standard for harvesting the saphenous vein for use in vascular and cardiothoracic bypass grafting. In an effort to reduce morbidity and complication rates in our head and neck reconstruction patients, we have explored the use of EVH in interposition vein grafting for use in free-flap reconstruction. This report is a description of the technique as applied to head and neck reconstruction.